Disclaimer: This is not personalized medical advice. It is intended to raise awareness of potential implications of treating illness while on the ketogenic diet. Contact your ketogenic diet team and primary care doctor to set up individualized protocols in the event of illness.

It’s cold and flu season. We’ve already been through a few minor colds this fall and early winter, but we are thankful that none of us have suffered much beyond a cold. It feels a little unfair when your keto-kid, who is already under medical treatment and scrutiny everyday (as much as we try to be “normal”), suffers from a virus or bacteria that takes over and makes her feel miserable.

But for a keto-kid, a typical virus or bacterial infection has the potential to spiral into a prescription to treat it, acidosis and/or a hospital stay.  If not handled properly, a medication or hospital stay has the potential to spiral into a loss of ketosis. A loss of ketosis has the potential to spiral into new seizures. All from a little virus? Yes, so be prepared.

Some of this information was gleaned from the Charlie Foundation Symposium on the Ketogenic Diet, which I attended in September. Other information came from our ketogenic diet doctor in the letter that he sent to Nora’s pediatrician after our last appointment with him (it’s nice that he copies us on the coordination of care letters). I’ve been intending to create a 1-page cheat sheet of do’s and don’ts in the event of an illness that goes beyond the sniffles, and I think every keto family should be aware of these issues if your medical team has not brought it up with you.

Talk to your doctors and make a plan for illnesses. As the parent, you are the one that is constantly in the room when your child is receiving medical care, and you are the last line of defense in making sure treatment is consistant with the ketogenic diet.

Prevention Prevention Prevention!

Ted has instituted a strict hand washing policy at our house, and it’s reinforced by both me and Nora’s nanny, Laura. Nora is indoctrinated: after using the bathroom and before eating, wash hands while singing ABCs. We also remind them to wash hands after we come back home from anywhere. We meet occasional resistance, particularly when Nora is hungry. We also meet sibling rivalry when both of them want to crowd into the sink at the same time (sheesh). But clean hands are the most effective way to avoid illness.

Get a flu shot! Our whole family had their flu shots as soon as possible this year. During our last visit to the keto clinic in October we asked about the risks and benefits of getting a flu shot, and Dr. Wray overwhelmingly was in favor of getting the shot. He tried to arrange for both kids to get the shots before we left his office, but the hospital wasn’t ready with the kids shots yet (he was frustrated!) They had to wait a few more days, but got their shots at their home clinic and had no problems beyond a sore arm. A dose of prevention.

Medications

The Charlie Foundation Symposium included a great talk by Michelle Welborn, PharmD (Doctor of Pharmacy). She went through several drug interactions and considerations for kids on the ketogenic diet. It didn’t occur to me before this talk that there might be common prescriptions to avoid. When Nora is sick and we have to take her in to urgent care or the pediatrician, I would not expect them to be aware of these details of the ketogenic diet so I will bring in my list of “don’ts” so that we can find the best possible course of treatment.

Many viral or bacterial infections in the respiratory system lead to inflammation which is commonly treated by steroids. However, be aware that steroids are anti-ketogenic. Using a steroid may decrease ketosis, which could potentially lead to a resurgence of seizures. Make sure that your pediatrician is aware of that fact and consult with your ketogenic diet team. The benefits of the steroids might be worth the risks of decreasing ketosis, but your team might have other treatments or give other recommendations for maintaining ketosis while on steroids.

Antibiotics are also commonly used to treat bacterial infections, from ear infections to pneumonia. Of course, the children’s formulations of the pink liquid will be full of carbs, so you will have to find an alternative delivery method (which we have thankfully not explored yet, but it’s worth noting). Michelle said that a class of antibiotics called cephalosporins (e.g., Keflex) are known to increase seizure activity in general. I’ve tried looking for more information about other antibiotics to avoid but have not found anything, so ask your doctor if there are antibiotics to avoid, based on his or her experience treating kids on the ketogenic diet.

As an aside, Michelle also noted that acetaminophen suppositories are available for pain relief. Thankfully, we have not had to go there. Of course, children’s acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) liquid formulas are full of carbs, so to administer a pain reliever to Nora we have crushed up the appropriate amount of an adult tablet (ask your pediatrician for the dosage based on your child’s weight before an illness strikes). It doesn’t taste good, but it can be taken with a shot of liquid or bite of cream cheese or butter. Michelle Welborn also noted that carbs can be absorbed rectally, so don’t try the children’s liquid formula as a suppository (I would not have been creative enough to consider it, but apparently someone has!)

The Charlie Foundation also maintains a list of low-carb and carb-free products, including typical over-the-counter products needed to treat an illness. Keep it handy.

Vomiting and Hospitalization

As we have mentioned before, many keto kids have high blood acid levels. It’s a common side effect of the diet. Nora runs a baseline high blood acid level now, even though she is on 2 packets of Cytra-K per day to bring it down (alternatively, the doctor refers to it as a low bicarb level). It is not at a level that makes her ill now, but if it gets lower she could get very ill from blood acidosis.

After our last visit with Dr. Wray at the keto clinic, his letter to Nora’s pediatrician gave this recommendation, which he stressed to us during the appointment as well:

If there is nausea or vomiting, she may promptly need IV fluids given her acidosis. Increasing her Cytra has not brought her bicarb up, it does not seem to be affecting her now, but certainly as we enter the viral season this may be an issue. Certainly if she is vomiting up her Cytra-K, she could fairly rapidly become excessively acidotic and may require help. If she does go to the emergency room, it is important that she not get intravenous fluids with dextrose or lactated Ringer’s as these will take her out of ketosis.

If Nora starts vomiting, our first call will be to Dr. Wray’s office to make sure he is aware of the situation and he can be in contact with the primary care doctor if necessary. Symptoms of blood acidosis are lethargy, vomitting … pretty much the stuff of the flu. So it would be difficult to impossible to tell if she is suffering from further acidosis if she gets sick. Dr. Wray is recommending to err on the side of precaution and get her extra fluids via IV if she cannot keep anything down.

If he recommends going to the ER for IV fluids, we will be sure to verify that her IV fluids do not contain glucose, dextrose, nor that they use a lactated Ringer’s solution, all of which are listed as contraindications in his last set of notes. I quickly looked up lactated Ringer’s solution and learned that it is a fluid containing dextrose and several minerals (potassium, sodium, calcium, chloride). Presumably she should have an IV solution containing minerals but without the dextrose, or with a much smaller concentration of sugar/starch. That is a question that I will put to Dr. Wray so that we know what she should get in her IV. If they have to mix a special solution, that will take time so we should know which off-the-shelf bag of fluids should be used immediately.

I was especially grateful to get these specific notes from Dr. Wray because this was also a topic of concern at the Charlie Foundation Symposium. Emergency rooms have done some real damage to keto kids because they do not have training in this special sub-set of medical issues. The technical discussion of appropriate IV solutions at the symposium was over my head, but keto teams around the world have experience in treating keto kids with an IV, so appropriate solutions are known. As the parent, you are the advocate in the room and have the final say on the treatment of your child. Usually a nurse or other tech comes in the room to administer the IV bag, so check with them before they start fluids and refuse to start the IV if the bag contains any of the contraindicated ingredients or solutions and get in contact with the doctor on-call. If you can go in with as much information and instructions as possible, you can stop mistakes before they happen.

Reminding the pediatrician and doctor on-call about these issues will start them down the right path, and getting your ketogenic diet doctor consulting as soon as possible will be critical. Writing this up still leaves me with some questions, so I have a little homework to do to continue to prepare our family for inevitable illness. In any case, there is value in knowing the where the dangers lie so that you can get the answers you need when you need them. And even better to be prepared ahead of time.

To borrow from an old bit of wisdom: Knowing is half the battle (GI Joe!)

Update: Dr. Wray responded to my unresolved questions about IV solutions: normal saline, or some dilution thereof with potassium are fine. The ER physicians will know this, and if not, can call the ketogenic diet team. He also said that he tries to avoid oral steroids, but inhaled ones and are fine if a kid has asthma or other needs. As for antibiotics, they are typically all fine (even the cephalosporins) as pills, as any break-through seizures are more due to the intercurrent illness, not the drugs to treat them.

Thanks Dr. Wray!

If you’ve followed Nora’s Special Diet, you know that I try out a lot of recipes. Some of them are one-hit-wonders. Some will come back for a special occasion or a change of pace. They’ve also been following seasonal availability of different vegetables over a year of the diet. But I thought it would be useful to peruse Nora’s daily food log and see what she eats on a regular basis and share that with you.

If you are thinking about the starting the diet or moving from Modified Atkins to a higher ratio, I find it helpful to think about the great foods that you CAN eat on the diet instead of all of the things you can’t eat. So many creative cooking parents have made great substitute for kids’ favorite foods, so eating keto doesn’t seem so weird after all! Nora’s list is a mix of regular natural foods right from the grocery shelf and great recipes created by parents. As always, double-check the nutritional information on the products you use and check with your dietician when in doubt.

I was also guided by my recent experience of being away from home for a few days in the last month, so I made sure that Ted had the go-to foods so that he can easily pull together meals while parenting 2 kids. It turned into a “top 15” list which is not particularly elegant, but I couldn’t exclude anything that made the cut, and couldn’t think of any more! Ranked unscientifically by my intuition about the frequency, ease, and deliciousness of each food. Drumroll, please………….

#1: B^3and 8 g apples

Our B^3 recipe has evolved since the original post, but I don’t think it’s particularly useful to post the changes. We’ve just jiggered the proportions as Nora’s ratio has increased and added coconut oil. This is her daily morning snack, also delivering her daily vitamin supplements.

1 snack serving of B^3 and 8 g apple. The silicone bowl we use is on the right and the tablespoon and apple are for size reference.

It is worth explaining how Ted has changed the B^3 portioning procedure to make it more efficient. He has taken over the B^3 lately and his way is pretty clever. First, liquefy the B^3 by warming it up (placing the container in a bowl of hot water works well). Measure each portion by pouring into a smooth-sided small silicone bowl. It’s darn nice to have about 7 or 8 of these. Crush each day’s supplement with a mortar and pestle and mix into the liquefied B^3. Place the silicone bowls in the refrigerator until hardened. Pop them out of the bowls and into a container–they will hold their shape! Dole out 1 per day with the appropriate amount of apple, 8 g for Nora to get her 3.5:1 ratio snack. No more daily crushing of vitamins. Save it for your weekend fun.

And this is a MUST HAVE snack for Nora. Don’t you mess with her PB and apples. The practicality plus frequency and love is why it’s #1. She is still capable of major meltdowns, and missing this morning snack has been grounds for a major meltdown. We can now substitute 12 g of carrots for the apples if Anders has eaten us out of our apples supply (which happens regularly).

#2: Flackers

Fabulous food, fabulous name: flax+crackers=flackers. They are simply pressed, baked flax seeds. We can buy them in the store and they are ready to go. Nora likes the rosemary version. I have not looked at the nutritional info for the new flavors (currant sounds good and carbier). Nora gets about 8-10 grams with a meal, at least once per day, which is about 2 crackers (they are about 4 g each but we weigh it out on the gram scale). Per gram of flacker, they have 0.04 g carbs, 0.2 protein, 0.3 fat, and 0.28 g fiber. By themselves, they are a 1.33:1 ratio and will hold 4-5 g of butter each to bring up the ratio of the whole meal. They have been with us since the beginning and we are addicted to Flackers.

#3: Bandon Natural Medium Cheddar Cheese

Who doesn’t love cheddar? Ok, the lactose intolerant and dairy allergies among us. Sorry. But for a kid who loves dairy, it has no carbs, 1.3:1 ratio of fat to protein. Chunks of cheddar for protein in a meal is easy, or shred it to top other foods.

#4: Olive Tapenade

We found a brand of kalamata olives (Peloponnese) with a 4.5:1 ratio so we are sticking to it. I have been surprised about the variation in the nutritional information on kalamata olives, so I think the brine must be important to the carb count. We serve the pitted kalamatas on their own as part of a meal, but I also made a recipe for Olive Tapenade with a 7.9:1 ratio because of the extra olive oil. It’s great to serve with Flackers and other lower-ratio foods to get the meal up to 3.5:1. I will post it soon!

#5: Tuna salad

I use Sea Star Tuna direct from the Oregon Coast and highly recommend using very high-quality canned tuna steaks. They are more expensive than your “chicken of the sea” variety, but I think it’s worth it for flavor and texture. We mix it with full-fat Greek yogurt and English Double Devon Cream because we don’t like mayo at our house, but there are plenty of recipes out there with mayo if you prefer. Nora eats it with a spoon.  My version is 2.1:1 ratio, but we sometimes stir in a little more butter to boost the ratio and Nora doesn’t notice the difference. I will also post our Tuna Salad recipe soon.

#6: Strawberries & Raspberries

I’m grouping them together because they have the same carb profile in our calculations (0.06 g net carbs per gram of berry) and we use them almost interchangeably (which is not true of blueberries, which have twice the carbs per gram of berry at 0.12 g net carbs). Fresh or frozen, Nora eats between 12-20 g of berries for a bedtime snack with her steamed cream and coconut oil every night. She often gets some berries with meals as well, and they are a incorporated in many other recipes.

#7: Steamer Creamer

Many keto kids drink heavy cream as a major source of fat. We use Organic Valley Heavy Whipping Cream, as our dietician said it is the only major brand that consistently has no carbs. Each tablespoon delivers 6 g of pure fat. To be sure we get all of the fat evenly distributed, we dump the carton into a pint mason jar and mix in any fat that congealed at the top or stuck to the sides. We put cream into Celestial Seasonings Sleepytime Vanilla Tea (carb and caffeine free) to accompany some meals. In the beginning, we heated it in a pan with a little cocoa powder for hot chocolate, or heated it in the microwave. Until…

One day we were visiting our friends Cora and Mike, who have a fancy espresso machine. They steamed Nora’s cream and she declared, “this is REAL hot chocolate!” Mike and Cora had been considering getting an even fancier machine, and we relieved their guilt and gave them a reason to buy the new one by taking their old one as a hand-me-down. Now Nora gets steamed cream every night, with coconut oil and a crushed calcium tablet mixed in. The steaming does a nice job of emulsifying the additions, and you can add a drop of vanilla flavoring or a touch of cocoa powder for flavor as well, but she doesn’t mind it straight up. Lately Ted has put 1 piece of her strawberries in for flavor.

And mama gets espresso at home: win-win-win. Thanks Cora and Mike.

#8: Avocado

Nature’s wonder keto food: 3.62:1 ratio, high in fiber and fat, low in carbs. Cut, weigh and eat. Comes in bio-degradable packaging.

#9: Red Pepper

Or orange or yellow, Nora’s not a fan of green. High in flavor and fiber and low in carbs (lower than berries at 0.04 g net carbs per gram of pepper). Nora probably averages 14 g of red pepper per day, which is about 2-3 spears for the rest of us. It’s a little package of vitamins and yum that really makes a meal feel normal and healthy.

#10: Fiber rolls

Roaring into the “top foods” category are little dinner rolls of “bread!” And any ratio! I make the 3:1 version. And 2.5 g fiber! Developed by keto-mom extraordinaire Dawn at ketocook.com, approved by the Charlie Foundation, gluten-free and really delicious. Even Anders agrees. Last time I made them, he saw one on Nora’s plate said whined, “awww man, why does just Nora get one? Can I have one too?” Honestly. I’m going to post an ode to fiber rolls with my tips on getting them to rise to their fullest.

#11: Cytra & Cream Gelatin Hearts

Nora gakes 2 packets of Cytra-K crystals each day, dissolved in about 2 cups of water and served at meals. It is a prescription formula of potassium citrate to combat high blood acid levels that are a side effect of the diet. The crystals are flavored with saccharine and colored with red dye. As you can tell by my “top foods” list, I would normally not include this in Nora’s diet but the alternative is to make her drink baking soda water. We tried that, and it’s horrible.

Nora loved her Cytra drink at first (it’s pink and sweet!) but it has lost its shimmer after drinking it daily. Lately she is thrilled when I make it into gelatin snacks in her heart-shaped molds. She gets 3 Cytra gelatin hearts per day with meals, with cream mixed in for an easy delivery of fat. Unflavored gelatine is pure protein, so it’s easy to incorporate into the diet. Again, I will post that recipe soon too.

#12: PBJ Muffins

This is a recipe from the Keto Cookbook. I adjusted the recipe (see link) for a 3.5:1 snack for Nora. In the Keto Cookbook, they use 1 batch as a 400 calorie meal. I weigh out the muffin batter so that they are all the same, and make it into a 110 calorie snack. No need to weigh the muffins, just grab and go (although we do have to weigh the topping of PB/butter and berry, less convenient). I make a few dozen at a time and freeze some. This is one that Nora has requested to eat even after her diet is over, and I agree. They are delicious.

#13: Cheddar Crackers

Cheddar Crackers

Also from the Keto Cookbook. I weigh out 5 g of batter for individual crackers and dole out the number of crackers that work in a meal or snack. We have quantified them on a per-cracker basis in our database rather than by the gram, because they are pre-measured (so convenient). I have made up to 60 crackers at a time, and frozen some for later use. I use the original 4:1 ratio in the recipe, so I can add another low-ratio foods, like some berries or some cheddar cheese to balance out a meal or snack. Again, this is one that Nora and I will continue to make after the diet is over. Then I will also be free to eat them and no pre-weighing! I admit to snacking on a cheddar cracker now and then, but I know I have to save them for Nora.

#14: Keto Pizzas

And another hit from the Keto Cookbook! I make 4 pizzas at a time when I have the ingredients out. Nora has 1 for dinner and I freeze the other three. Pull one out of the freezer and put it in a 400 degree oven for 5-10 minutes. Happy Nora, happy mama on a night when I just don’t want to cook or when we have a babysitter. It’s pretty much perfect for a whole meal.

#15: Chocolate Chip Ice Cream Pops

This one made the list because Nora is demanding one for every afternoon snack lately. And who can blame her? They have chocolate chips made with fancy 85% dark chocolate and the ice cream is made with real vanilla bean. They are a labor of love, but I’ve figured out how to make a big batch so I don’t have to do it so often. And I make a batch of ice cream for the rest of us at the same time. It’s win-win again! Recipe and procedure to be posted soon!

I’ve promised you 4 recipes: Olive Tapenade, Tuna Salad, Cytra-Cream Gelatin Hearts, Chocolate Chip Ice Cream Pops, and my tips on Fiber Rolls. I really wasn’t trying to hold out on you, honest. I’ll get right on that. Ted has also been scheming a post with the daily routine. He has been putting together Nora’s lunches in preparation for days when we are at work.

And as an aside, we’ve noticed that Nora’s diet is almost 100% gluten free by default. Macadamia nuts are the secret ingredient in the baked goods. She used to eat a low-carb, high-protein tortilla, but she hasn’t wanted it lately and the last time she ate one, she had a rash on her face the next day. We are keeping an eye on that and will try an elimination diet approach: remove all gluten again for several weeks until her face is clear and offer gluten again to see what happens.

Finally, here is a typical meal and the breakdowns to get a sense of a meal with these foods. Seven out of the 15 are here, plus butter (which is a daily thing but didn’t deserve to make a “top food” list). Values all in grams. This was lunch on October 6: 350 calories, 2.5 g net carbs out of 10 g total for the day.

And for the visual (cream not pictured):

One of my first images of the ketogenic diet is the picture used in the NYT magazine article, Epilepsy’s Big Fat Miracle:

Stephen Lewis for The New York Times; Food Stylist: Brett Kurzweil

That made my stomach turn a little bit. Now that Nora has been on the diet for 8 months, we know it’s not quite like that. We eat bacon about once a month. Nora gets about 4 slices total over a few days when I make up a package. She eats WAY more butter than this, but less cream nowadays. And WAY more macadamia nuts. And avocados aren’t in the picture! So I’ll update the picture with one of my own, from last night’s stock-up grocery shopping trip:

Feeding a kid on the ketogenic diet is not cheap, particularly if you are looking for high-quality fats. Pictured are some of the big-ticket items that I picked up for Nora last night. Some will last for several months, like the coconut oil. I’m not sure if this 5-pound bag of macadamia nuts will last us the month, but it will come close.

Now the saving money part: On the second Tuesday of every month, our local natural foods co-op, First Alternative, has Owner Appreciation Sale Day. Member-owners get 10% off their entire purchase! Even better, member-owners can order a case of any product for a 10% discount. Pick it up on owner sale day, and you get the additional 10% sale day discount off the discounted case price. Genius. They don’t hide this possibility, but I’m not sure that many people know about it. Your local co-op or grocery store might offer similar discounts on case orders; it’s common at all of the co-ops I’ve shopped. And it doesn’t hurt to ask.

I’ve mentioned before that I bought English Double Devonshire Cream in a case of 12. At $8.89 per jar, that’s some savings. Now that we are using less Double Devonshire Cream (Nora no longer eats “Norgurt” every day now that she is off Depokote sprinkles), I just buy a few at a time on owner sale day to last the month. It’s my mayo substitute (we hate mayo). I have been ordering a case of Primrose cream cheese, which comes in a 3-lb brick and costs $12.87, so we save $1.29 on the case discount and another $1.16 on owner sale day, for a $2.45 savings.

But that is small potatoes. We have dramatically increased our use of other high-priced items in recent months. Coconut oil and macadamia nuts are now staples, and we go through them like crazy. A 12-16 oz jar of coconut oil will cost between $8 and $12. This month I ordered a 7.5 pound jar of coconut oil, pictured above. It will keep indefinitely, so I will refill our smaller jar for daily use. The original price for the whole jar is $65.18, or $8.69 per pound. The case discount subtracts $6.51, then the sale day discount takes off another $5.37, for a total savings of $11.88. Now we’re talking savings.

We’ve also been going through macadamia nuts like crazy. After grinding them into butter, they are the main ingredient of many of Nora’s baked goods. Ted went to the store and bought some from bulk one day, which sell for $18-20 per pound, depending on the store. When the cashier weighed them, they came to over $40. She suggested that he could put some back (some friends will remember that Ted came home with a $40 bag of arborio rice the size of his head one day, so he’s got a reputation for “bulk” buying). But in the case of the macadamia nuts, we needed them all and he declined the opportunity to put some of them back.

The 5-pound bag of macadamia nuts pictured is a case, ringing in at $89.45, which is $17.89 per pound. The case discount is $8.94, then the sale day discount takes off another $7.55. That’s a $16.49 savings! Now I can justifying buying a nice bottle of wine for after the kids are in bed.

A few other things above that I did not buy in a case, but add up to significant savings with 10% off on owner sale day:

• 2 bottles Double Devon Cream: $17.78; $1.78 savings
• 2 Rotolini, reg, $8.89, on sale for $7.39 before discount; $5.48 total savings
• Greek Gods Traditional Plain Yogurt: $2.99; $0.30 savings
• Almond Oil (trying for the first time): $10.99; $1.10 savings
• Small bottle Carlson Fish Oil: $22.69; $2.27 savings
• Avocados: on sale 2 for $3; $0.30 savings
• Organic Valley Heavy Cream: $3.79; $0.38 savings

Adding up everything I bought yesterday for the whole family, I saved $34.08 on the owner sale day discount and a total of $21.05 on the case discounts. $55.13 total savings, not including sale prices on some of our regular products. That helps the food budget a whole lot.

They say that non-compliance is the main reason that people stop the diet, not lack of efficacy (although it doesn’t work so well for everyone). Non-compliance seems to mean that the kid won’t accept eating like this, but getting compliance must depend heavily on what you are asking the kid to comply with. That puts a lot of pressure on the parent to get compliance. It’s a lot of responsibility. And the best thing we can do for ourselves as parents is to make our job as easy as possible.

Some kitchen equipment just adds a lot of work to your life. Maybe it takes a long time to clean. Maybe it is difficult to get the food in or out. Maybe a recipe makes too many dirty dishes and takes too many steps. Those are the gadgets and recipes that won’t survive the test of time. Weed them out. Let them fall by the wayside, because you have enough work to do.

Here are 3 kitchen gadgets that I’m very happy I found:

(Starting top right): Tovolo Ring Pops, Tovolo Ice Cream Pop Molds, Silpat baking mat

• Silpat silicone baking mat: I had been using parchment paper or silicone muffin cups for baking individual portions. I felt like some of the fat was left on the parchment paper, and the food didn’t slide easily on the paper when putting the batter down, making it difficult to work with. Making each portion of something small and thick enough to bake on a sheet, like cheddar crackers (pictured, recipe from the Keto Cookbook) just made a lot of dishes to wash. Now, I use one of my little silicone pinch bowls to measure out a 5 g portion of cheddar cracker, transfer it to the Silpat, then measure the next, and so on. Once they are all on the mat, press each down into a small cracker shape. Sounds like a small thing to change this procedure, but when you are making 20 crackers at 5 g each, every little saved motion and moment helps. It costs about $30, which gave me pause on previous equipment buying trips, but it was worth it. Beautiful results, easy to use and clean, and will last forever.
• Tovolo Ice Cream Pop Molds: I saw these at the store a few months ago but did not buy them because they seemed kind of large and I couldn’t estimate the amount that they would hold. Thanks to Dawn at the ketocook blog, I learned that they hold about 50 g of popsicle each. Making her strawberry popsicles in these are a little on the large side for Nora’s snack and contain a lot of carbs for her in one serving, but she loves them and they are worth planning them into her day. I’ve adjusted the recipe just a bit for Nora to bring down the carbs. At around $10, they are sturdy, fun and wonderful to get a kid happy about her food.
• Tovolo Jewel Pop Molds are also great fun, but they are less functional. They are made of cheaper plastic and I find them a bit hard to take out after frozen. They hold around 30 g of strawberry popsicle, but because they are different shapes I haven’t wanted to keep track of how much each one holds. The few times I have used them for ice cream, I’ve just made a few of the same weight to keep track. Instead of using them for ice cream, I make CALM lemonade pops with 1 g of raspberry each. The CALM lemonade is a “free” drink for Nora, a mild magnesium-calcium laxative with a bit of lemon flavor, sweetened with stevia. I can keep track of that 1 gram of raspberry, but could be made without it. She can also have a few of them if she wants to because that little bit of raspberry can be easily absorbed into a snack or meal for her (I know some kids are more sensitive and would probably need that balanced out). It’s something I can give to her on demand and she can choose her ring pop shape, which gives her some satisfaction and a small bit of control.

We are still somewhat amazed that Nora is so compliant with the diet, but I think that a few things have contributed to her acceptance. First, we started experimenting with the low-glycemic index approach, then officially started diet treatment with the Modified Atkins (MAD) version of the diet, which meant less immediate dramatic changes to the way she eats. We’ve eased into a stricter form of the diet over time, which has let us experiment and find what works for her. We did not have to learn this whole process overnight.

Our gradual process also allowed us to start with a focus on what she accepted in her diet, rather than starting with a “prescription” diet formulated from the outside. Recipes could be adjusted and new recipes discovered that met the requirements of stricter forms of the diet. Favorite foods could be accommodated or amended. Everything that we presented to her was “sold” with an emphasis on what she likes about it. That is not to say that everything was a hit, but kept a focus on the positive.

Once we were motivated by the diet’s seizure control success and we knew that we were in it for the long haul, we’ve made these small changes and purchases to make everyday life a little easier. We discovered other resources, like the Keto Cookbook and the ketocook blog and started putting more effort into streamlining our process. I have definitely favored “easy” recipes along with favorite recipes.

Compliance should refer to parental compliance as much as child compliance. This treatment is relentless, and it’s all up to the parents. Every day, every snack, every meal. It seems like it never ends (taking a page from Nora’s playbook here). There is always more to learn and more to discover, but what really matters is what works for your kid, both in seizure control and acceptance, and also what works for you, the parent, to get a great meal or snack on the table 3 to 5 times per day. Be kind to yourself and be as easy as possible.

Some days you realize that you’ve run out of everything. We also have a trip to Portland to the KetoClinic tomorrow, and we are going to the coast for the weekend, thanks to Ted’s colleague, Annette and her family, for letting us use their beach house. It’s so great to have a kitchen! We will also get to see one of Nora’s best little friends, Ingrid, who has been in Eastern Oregon this summer. Lots to look forward to–and we don’t want to stress about food.

In my kitchen today: A new batch of B^3, a new and improved formulation that will include coconut oil in order to boost the fat content a bit more. Now that Nora consistently expects B^3 and apples or carrots for her morning snack, I am changing the formulation to make that whole snack 3.5:1, now that we are in the groove at the new ratio. I am not planning to post the new recipe, but if anyone wants it just let me know. It was time to buy a big new jar of Adams Natural Peanut Butter for another batch. Just mixing in the naturally-separated peanut oil is a job, and it’s only step 1!

I’m also making a new hazelnut-coconut oil breakfast cookie that is 3.5:1. I have not tried my new formula yet, but if it works it will be a great basis for breakfast and we will not have to separately deliver coconut oil. It can also be used for a quick self-contained snack. I had to buy more Bob’s Red Mill Hazelnut Meal/Flour today. That stuff is finely ground gold–$10.99 for a 14 oz bag! At least I don’t have to grind it myself. Unlike macadamia nuts, which are almost $20 per pound and I do have to grind myself.

Cheddar Crackers

Earlier this week I made some cheddar crackers and PBJ muffins. The cheddar cracker recipe is right out of the Keto Cookbook, and they are so good. Anders thinks they taste like cheese puffs, but we do our best to reserve them for Nora. 🙂

I might try my hand at the basic keto pizza recipe from the Keto Cookbook tonight, but I might just be done with cooking by the time I get to it. Step 1 for that recipe will be grinding the macadamia nuts. I will also have to analyze the recipe and put it in our KetoCalculator spreadsheet before Nora can have it. Sigh, I guess that one will probably wait for another time.

How ironic. After I finally make a post about our KetoCalculator spreadsheet, we had a problem this morning. There was some glitch in updating the spreadsheet on Google Docs, so Ted and I were not seeing the same version, and the version showing up on my computer disagreed with our written notebook record of breakfast and snack for the day. It was a very strange mistake and we can’t figure out when or why it happened, but it is another lesson in checking and double checking, keeping good records, and working together.

The good news is that Nora’s meals for the day were not impacted. They were calculated on the correct information. Even with fancy calculating technology, we still have to keep a sharp eye out for anything that just doesn’t look right. Don’t get me wrong, I’m thrilled to have our KetoCalculator and it wouldn’t have happened if Ted had not taken the initiative to build it. It took a little bit of time to transition to using it for all meals, but it has been a great help overall. Now that we have seen our first glitch, we know to double check totals, keep our cool and track down problems.